Department of Radiology, Neurology, and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611-2927, USA.
J Neurointerv Surg. 2011 Dec 1;3(4):324-30. doi: 10.1136/jnis.2010.004036. Epub 2011 Feb 18.
Bioactive polyglycolic/polylactic acid (PGLA)-coated Matrix detachable coils were reported to incite intra-aneurysmal inflammation and fibrosis. Multiple large case series with Matrix-1 coils have shown no advantage with respect to aneurysm recurrence. Second-generation Matrix-2 coils were designed with improved platinum support and reduced copolymer friction. We assessed the safety and efficacy of Matrix-2 coil embolization.
84 aneurysms were embolized primarily with Matrix-2 coils. Anatomic results were evaluated using a modified Raymond scale with progressive occlusion or recanalization/recurrence strictly defined as any interval change in intra-aneurysmal opacification.
Mid-term (8.9 ± 3.4 months) and long-term (23.0 ± 7.4 months) follow-up was available for 65 aneurysms. At mid-term, 55 (85%) aneurysms remained stable (or progressed to occlusion) versus 10 (15%) recurrent aneurysms, 7 (11%) requiring retreatment. At long term, 49 (75%) aneurysms remained stable versus 16 (25%) recurrent aneurysms, 12 (18%) requiring retreatment. Statistically significant factors affecting recanalization included ruptured aneurysms 9/20 (45%), large aneurysms 5/8 (71%), post-procedure residual aneurysms 6/12 (50%) and differential coil packing density of recurrent (21%) versus stable (28%) aneurysms. Patient morbidity (5%) was limited to thromboembolic complications (n=4) or aneurysm rerupture (n=1). Patient mortality (5%) was secondary to subarachnoid hemorrhage complications (n=4) with no procedure-related deaths (0%).
Coil embolization with Matrix-2 coils is safe and effective, preventing recanalization in small aneurysms at mid-term. Although these aneurysm recurrence rates initially appeared lower than previous reports with Matrix-1 or platinum coils, significant late recanalization was observed on long-term follow-up. We postulate that any derived benefit from Matrix-2 coils is directly dependent on post-procedure outcomes and coil packing density.
已有报道称，具有生物活性的聚乙醇酸/聚乳酸（PGLA）涂层 Matrix 可分离式线圈会引发颅内动脉瘤内炎症和纤维化。多项 Matrix-1 线圈的大型病例系列研究显示，其在动脉瘤复发方面并无优势。第二代 Matrix-2 线圈的设计采用了改良的铂金支架和减少的共聚物摩擦。我们评估了 Matrix-2 线圈栓塞的安全性和有效性。
84 个动脉瘤主要采用 Matrix-2 线圈进行栓塞。采用改良的 Raymond 分级标准评估解剖学结果，渐进性闭塞或再通/复发被严格定义为任何颅内动脉瘤显影的间隔变化。
65 个动脉瘤可获得中期（8.9±3.4 个月）和长期（23.0±7.4 个月）随访。中期时，55 个（85%）动脉瘤保持稳定（或进展为闭塞），而 10 个（15%）动脉瘤复发，7 个（11%）需要再次治疗。长期时，49 个（75%）动脉瘤保持稳定，16 个（25%）动脉瘤复发，12 个（18%）需要再次治疗。影响再通的统计学显著因素包括：破裂动脉瘤 9/20（45%）、大动脉瘤 5/8（71%）、术后残留动脉瘤 6/12（50%）和复发动脉瘤（21%）与稳定动脉瘤（28%）的线圈填充密度差异。患者的发病率（5%）仅限于血栓栓塞并发症（n=4）或动脉瘤再破裂（n=1）。患者死亡率（5%）继发于蛛网膜下腔出血并发症（n=4），无手术相关死亡（0%）。
Matrix-2 线圈栓塞是安全有效的，可在中期防止小动脉瘤再通。尽管这些动脉瘤复发率最初似乎低于以前的 Matrix-1 或铂金线圈报告，但在长期随访中观察到明显的迟发性再通。我们推测，Matrix-2 线圈带来的任何益处都直接取决于术后结果和线圈填充密度。
